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BUSINESS,CERTI KATE# I J <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNO'FMASHPEE DATE /0 - - - <br /> • Expiration Date: <br /> Inconformity with the provisions of Chapter 110,§5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of n <br /> Business Name/DBA: l L`%NG*sOvl �ZfV\ �AV• 4e I,C r'�C ro por tion Name: <br /> is conducted at Business Location: �� CQ �{ V�O\ t!P IMA<�1 Commercial_ Residential <br /> Business Mailing Address: 0\ '-2 Ob ]"\Ph SZP/rJ5 {�\t � IS , ANN, O-LZ74B /�{ <br /> Business Type: ���1Dec A(�� SSI G Business Telephone: 5o <br /> New Renewal [ ] Home Phone: . <br /> Email Address: \Y\t\ COyrcOSA , n I <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Ce .!� ua ,. �9-\i n M aslya <br /> Second Owner Name Second Owner Address <br /> 0 ify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as required under law. <br /> �L/- '9� 9/ g <br /> *Signature of authorized agent **Social Security Number or <br /> or Federal Identification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> Name: Telephone Number: <br /> Alarm Company: <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment,obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATECtCIyk�er t oOlt( <br /> Personally appeared before me the above-named`\Jf G r 2 C v� A e o )L and made oath that the foregoing statement is true. <br /> A certifiq6te issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years thereaft so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> ,",ned ` <br /> Not Public <br /> SEA ��My Notary Public q _ a a - Do I-) <br /> . Margaret C.Santos Commission Expires: <br /> Commonwealth of Massachusetts <br /> Commission Expires on Sept.22,20t 7 <br />